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119th CONGRESS
1st Session |
Expressing the sense of the House of Representatives that the Wasteful and Inappropriate Service Reduction Model undermines beneficiary access to health care and should not be implemented.
Mr. Pocan (for himself, Ms. Schakowsky, Mr. Doggett, Ms. Ocasio-Cortez, Ms. Tlaib, Mrs. Watson Coleman, Mr. Landsman, and Ms. Goodlander) submitted the following resolution; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned
Expressing the sense of the House of Representatives that the Wasteful and Inappropriate Service Reduction Model undermines beneficiary access to health care and should not be implemented.
Whereas the Center for Medicare and Medicaid Innovation proposed a program called the Wasteful and Inappropriate Services Reduction (WISeR) Model to commence on January 1, 2026;
Whereas the WISeR Model proposes to increase the number of services that require prior authorization in traditional Medicare by 30 percent;
Whereas the WISeR Model proposes to contract with private companies that are currently administering prior authorization processes for private insurance companies, including Medicare Advantage companies;
Whereas the WISeR Model proposes to use enhanced technologies, including artificial intelligence and machine learning, to process the expanded prior authorizations in traditional Medicare;
Whereas prior authorization has become an obstacle to needed medical care for patients;
Whereas, according to the American Medical Association, 89 percent of physicians report that prior authorization contributes to physician burnout;
Whereas, according to the Medicare Limited Data Set published by the Centers for Medicare and Medicaid Services, private companies targeted for participation in this model have a demonstrated record of incorrect decisions on prior authorization requests, are 81.7 percent of denials made by Medicare Advantage insurers overturned once appealed, according to the Kaiser Family Foundation; and
Whereas, according to an article in Fierce Healthcare, tools using artificial intelligence to review coverage decisions developed by private health insurance companies, like those targeted for participation in the WISeR model, are reported to have 90 percent error rates: Now, therefore, be it
Resolved, That the House of Representatives—
(1) expresses disapproval of the Wasteful and Inappropriate Service Reduction (WISeR) Model;
(2) finds that expanding prior authorization processes used in Medicare Advantage into the publicly administered traditional Medicare Program undermines beneficiary access to timely and necessary medical care; and
(3) strongly requests that the Centers for Medicare and Medicaid Services terminate the WISeR Model.